How to Prepare for a Preoperative Pulmonary Evaluation

Imagine you're planning a long trip. Before your journey, you'd inspect your vehicle to ensure that it's in good working condition. You'd do all the necessary checks and improvements for a smooth ride.

Preoperative pulmonary evaluation is a similar check that's done before any surgery to ensure your lungs are healthy. 

A preoperative pulmonary examination will determine if you have any pre-existing conditions that would put you at risk of complications during surgery.

What's a Preoperative Pulmonary Evaluation?

Preoperative Pulmonary Evaluation is a formal assessment performed before surgery. It helps screen for conditions that may complicate a patient’s recovery and increase the risk of postoperative complications like respiratory failure.

Patients with complex medical history or comorbidities require special care during and after the surgery. A pulmonary evaluation before surgery allows your doctor to take the necessary precautions to avoid postoperative problems.

Generally, your doctor will ask questions about your medical history, take your vital signs and perform a physical examination. However, sometimes, it may include a chest X-Ray, PFT(Pulmonary Function tests) and ABG (Arterial Blood Gases) test.

A pulmonary function test checks your lung function, lung volumes, tidal volume, vital capacity, residual volume, total lung capacity, and overall airway health. It also tests for infectious diseases like tuberculosis and hepatitis. This helps the anesthesiologist (the doctor who administers anesthesia) know if your lungs are suitable for anesthesia and whether you’re at risk of infection.

An arterial blood gases (ABG) test measures the acidity and the oxygen and carbon dioxide levels in the blood. It finds out how efficient your lungs are in exchanging oxygen and carbon dioxide.

Why Is Preoperative Pulmonary Evaluation Essential?

Pulmonary complications or respiratory failure are the main reasons for postoperative complications and death in surgical patients.

It is natural to be stressed before any surgery, but stress with anesthesia can drastically influence your lung physiology. It can change your lung volume, respiratory rate and muscle function, thereby contributing to postoperative complications. 

A preoperative pulmonary evaluation identifies these risk factors and helps surgeons plan a strategy to reduce them. Based on this evaluation, your surgeon can decide the dose of anesthesia or modify any postoperative support.

The various complications that can arise after surgery are:

• Atelectasis—partial or complete collapse of the lung.
• Infection, including bronchitis and pneumonia
• Postoperative pneumonia 
• Respiratory failure
• Exacerbation of underlying chronic lung disease
• Bronchospasm—tightness in your chest that makes breathing difficult.
• Pleural effusion—Build-up of fluid in the lungs.

Pulmonary function tests are performed as part of a medical evaluation to rule out or confirm the presence of pulmonary disease. This test can also predict your lung's response to surgical intervention. 

While the following tests are not diagnostic of underlying conditions, they provide information that can help the anesthesiologist recognize and manage respiratory problems.

What Are the Benefits of Preoperative Pulmonary Evaluation?

A thorough history and physical examination are key components of a preoperative evaluation.

The pulmonary component of this evaluation assesses the patient’s respiratory system and its ability to function correctly.

The benefits of preoperative pulmonary evaluation are listed below.

• Identifies the risk factors
• Minimizes risk by adopting a tailored approach 
• Helps to optimize the dose of anesthesia
• Assists in planning the postoperative care
• Evaluates the benefit to risk ratio
• Improves surgical outcomes
• Reduces postponed or canceled surgeries.
• Reduces complications after surgery

How to Prepare for a Preoperative Pulmonary Evaluation?

Preoperative pulmonary evaluation is an analysis of your lung health. Hence, certain general preparations before surgery are also followed here. Let’s look into it.

• Inform your doctor about all your current medications. You might need to stop them before the procedure.
• Your doctor might sometimes request additional blood tests before your evaluation test.
• Ensure an empty stomach ahead of the procedure. Your lungs may not fully inflate if you eat a heavy meal.
• Avoid caffeinated drinks for at least four hours before the test. Caffeine improves your breathing by opening the airways and can misinterpret the results.
• Abstain from smoking right before the test. 
• Avoid heavy workout as it interferes with lung function.
• Wear loose-fitting clothes that do not hinder normal breathing.
• You'll be asked to sign a consent form agreeing to the procedure.

Your doctors may also promote smoking cessation, suggest weight loss or recommend exercises to reduce complications. Depending on your medical condition, they may recommend additional tests in your preoperative pulmonary evaluation. 

What to Expect After a Preoperative Pulmonary Evaluation Test?

This test may make you feel dizzy, especially if you have a lung or breathing disorder. This is just the body's natural response to the high flow of oxygen and increased ventilation. It's advisable to take some rest until you're feeling normal.

Your doctor will discuss the results with you and notify your surgeon about any concerns.

A preoperative pulmonary evaluation is a simple procedure, and if you have any concerns, you can talk to your doctor. Your doctor will guide you through the whole process.